Disparities in Care Among Patients With Cardiac Implantable Electronic Devices Undergoing MRI

Importance: Abundant data now demonstrate safe use of MRI for patients with non-MR conditional cardiac implantable electronic devices (CIEDs). However, CMS does not currently reimburse these examinations. Objective: Determine whether differences in reimbursement between commercial insurance carriers and CMS are impacting the completion rates of MRI examinations ordered in patients with non-MR conditional CIEDs. Methods: This study retrospectively examined patients with non-MR conditional CIEDs for whom an MRI was ordered between January 1, 2015, and August 31, 2016. Completion rates of MRI in patients with Medicare or Medicaid insurance were compared with those in patients with commercial insurance. Before November 7, 2015, all patients with non-MR conditional CIEDs underwent MRI examinations at no charge to the patient regardless of insurance. After that date, outpatients with only Medicare or Medicaid insurance coverage received an Advanced Beneficiary Notice that informed them that they would have to pay out of pocket for the entire cost of their MRI examinations. Results: Of 143 MRI examinations ordered, 127 met inclusion criteria for analysis. In the post-Advanced Beneficiary Notice period, outpatients with commercial insurance were significantly more likely to complete their MRI examinations (19 of 22 patients, 86%) when compared with patients with Medicare or Medicaid insurance (1 of 36 patients, 3%; P < .0001). No significant difference was observed in the inpatient setting. Conclusions: Due to CMS coverage policies based on now outdated concepts about MM safety, patients with non-MR conditional CIEDs and Medicare or Medicaid insurance are undergoing significantly fewer appropriate diagnostic MRI examinations than patients with commercial insurance.